Transcript GreenLight PVP for Treatment of Benign Prostatic Hypertrophy

RevoLix
New Laser for Surgery
林口長庚紀念醫院
高齡泌尿外科
崔克宏醫師
Introduction
• BPH is a major cause of LUTS in men
• Half of all men over the age of 50 will
develop this condition, also known as
Benign Prostatic Hyperplasia
• By the time a man reaches his 70's or 80's,
80% will experience urinary symptoms
• Benign prostatic hyperplasia (BPH) is a
common disease process that affects an
age
Epidemiology of BPH
Histologic Prevalence Around the World
100
90
Prevalence (%)
80
Pradhan 1975
Swyer 1944
Franks 1954
Moore 1943
Harbitz 1972
Holund 1980
Baron 1941
Fang-Liu 1991
Karube 1961
70
60
50
40
30
20
10
0
20-29 30-39 40-49 50-59 60-69 70-79 80-89
What’s LUTS?
Voiding (obstructive)
symptoms
• Hesitancy
• Weak stream
• Straining to pass urine
• Prolonged micturition
• Feeling of incomplete
bladder emptying
• Urinary retention
Storage (irritative or
filling) symptoms
• Urgency
• Frequency
• Nocturia
• Urge
incontinence
LUTS is not specific to BPH – not everyone with
LUTS has BPH and not everyone with BPH has LUTS
Blaivas JG. Urol Clin North Am 1985;12:215–24
Surgical Treatment
• Transurethral resection of prostate (TURP), Gold standard procedure
• Laser prostatectomy:
GreenLight PVP
RevoLix : Thulium laser
雙極利尿雷射 UROLAS 980
The TUR-P
•Indication :
•Contraindications :
•Procedures : ???
•Complications :
TUR-P
Laser Prostatectomy
1. PVP
2. Thulium
3. Diode
ABSORPTION vs.
AVELENGTH
120W
70W
200W
980nm is 2300 times more absorbed in H2O than 532nm
532nm is 74 times more absorbed in HbO2 than 980nm
Thulium laser vaporization
for Benign Prostatic
Hypertrophy: Outcome
林口長庚紀念醫院
高齡泌尿外科
崔克宏醫師
RevoLix: Laser Type and Specification
Laser type:
Diode Pumped Solid State Laser
DPSS (Thulium 銩 Laser)
(The 2 micron laser is excited by
an internal diode laser.)
Wavelength:
2 micrometer
Power:
5 Watt – 70 Watt, adjustable
Operational mode:
Continuous Wave (cw)
Chopped:
50 milliseconds to continuous
Delivery system:
Flexible silica fibres
Optical Penetration Depth
Diode 980nm
KTP
Diode
532 nm
830 nm
RevoLix銩雷射
Nd:YAG Ho:YAG
1064 nm
0.8 mm
CO2
2100 nm
10 m
0.4 mm
0.02 mm
5 mm
10 mm
Tissue
RevoLix: Fields of Application
Endourology:
TUR-Laser,
Opening of Strictures,
Incisions, Excisions,
Ablation of Bladder
Tumours.
Open Urology: Excision of Tumours from
the Cortex of the Kidney,
Bladder Surgery.
Prostate tissue after
VapoResection with RevoLix
X20
X40
X100
No deep penetration ! Only 0.2 mm necrosis
Remove Mediam lobe of
Prostate
Remove Lateral lobe of
Prostate
RevoLix in Urology: Ureter
Stricture
術前
術後
• To evaluated the clinical outcome of BPH
Materials and Methods
• Between Oct 2007 and May 2009
• The age of 54-94 (average 76.4)
• 80 patients with BPH treated with Thulium
laser therapy
Patients
•
•
•
•
Acute urinary retention: 38 (47.5%)
Pre-OP PSA: 3.6-28.53 (mean 8.78)
Preop PV: 43.5-120 mL (mean 85mL)
T-zone: Mean 58mL
Categories of information evaluation for assessing the results of implementing Thulium laser
Category
Lab test
Radiology
Pharmacology
OP&
Anesthesia
Specific test
Others
Admission
Day1(OP)
Day2(dischage)
CBC,U/A, Bun Cr, EKG
Sugar, Na, K, Cl, albumin
CXR, KUB
IVF
antibiotics
C
IM analgesics
Analgesics (oral) C
Antibiotics(oral) C
OP permit
nursing prepare
anesthesia prepare
TRUS
urodynamics
vital signs
fleet enema
NPO
PVP
C
Diet
3 way foley, irrigationRemoving foley
Results
• OP time: median 1.45 hours
• Hospital stay (mean): 2 days
• 75 (93%) need overnight irrigation for
<12hours
• Mean duration of catheterization: <16
hours
Results of Thulium laser in 80 patients
Initial
3 months
6 months
12 months
8.7+4.5
6.8+5.0
6.2+4.7
Peak flow (ml/s) 2.3+3.7
16.5+5.1
16.4+5.2
14.8+6.1
QOL
1.04+0.65
1.04+0.65
1.64+0.92
AUA-SI
27.7+5.7
4.4+1.1
Morbidity Profile
Iterm
No
Incidence%
Incontinence
0
0
UTI
5
6.2
Hematuria
1
1.25
Urine retention
2
2.5
Reop for check bleeding
1
1.25
Impotence
0
0
Bladder neck stenosis/stricture
1
1.25
Prostate cancer
6
7.5
Conclusions
• Thulium laser offers rapid tissue ablation
and resection in patients with BPH
• The laser is a new technology to most
urologists, the expense, safety precautions,
long term effectiveness, and general
acceptance
Thank You